Scientific article
Open access

Can VA-ECMO Be Used as an Adequate Treatment in Massive Pulmonary Embolism?

Published inJournal of clinical medicine, vol. 10, no. 15, 3376
Publication date2021-08
First online date2021-07-30

Introduction: Massive acute pulmonary embolism (MAPE) with obstructive cardiogenic shock is associated with a mortality rate of more than 50%. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been increasingly used in refractory cardiogenic shock with very good results. In MAPE, although it is currently recommended as part of initial resuscitation, it is not yet considered a stand-alone therapy. Material and Methods: All patients with MAPE requiring the establishment of VA-ECMO and admitted to our tertiary intensive care unit were analysed over a period of 10 years. The characteristics of these patients, before, during and after ECMO were extracted and analysed. Results: A total of 36 patients were included in the present retrospective study. Overall survival was 64%. In the majority of cases, the haemodynamic and respiratory status of the patient improved significantly within the first 24 h on ECMO. The 30-day survival significantly increased when ECMO was used as stand-alone therapy (odds ratio (OR) 15.58, 95% confidence interval (CI) 2.65–91.57, p = 0.002). Nevertheless, when ECMO was implanted following the failure of thrombolysis, the bleeding complications were major (17 (100%) vs. 1 (5.3%) patients, p < 0.001) and the 30-day mortality increased significantly (OR 0.11, 95% CI 0.022–0.520, p = 0.006). Conclusions: The present retrospective study is certainly one of the most important in terms of the number of patients with MAPE and shock treated with VA-ECMO. This short-term mechanical circulatory support, used as a stand-alone therapy in MAPE, allows for the optimal stabilisation of patients.

  • Cardiogenic shock
  • Massive acute pulmonary embolism
  • Thrombolysis
Citation (ISO format)
GIRAUD, Raphaël et al. Can VA-ECMO Be Used as an Adequate Treatment in Massive Pulmonary Embolism? In: Journal of clinical medicine, 2021, vol. 10, n° 15, p. 3376. doi: 10.3390/jcm10153376
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Article (Published version)
ISSN of the journal2077-0383

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